Student notes on Samuel Shem’s House of God extract

In an interview, there is a funny post about his reasoning for the pseudonym:

Q. It was published under a pseudonym. Did anybody know you’d written it?

A. People in the Boston medical world knew it was me. I was just starting my practice as a psychiatrist and I thought I could prevent my patients from seeing me as this radical, sexy, young guy. But they all found out immediately.

Furthermore, from what I read online, his publishings were bold anti-system workings. A lot of people were unimpressed by his work. From other articles and interviews I read about Bergman, he was not very well liked at first. At the time of his publication, the older generation of doctors really didn’t like him, and numerous schools refused to have him participate in talks or presentations at their school. 3

The author’s real name is Stephen Bergman, he was a practicing psychiatrist, graduated from Harvard medical school. Also, was a recipient of Rhodes scholarship from Oxford. He’s written a few novels (Mount Misery, FINE). Mount Misery is actually the sequel to “House of God”. Generally these are based on psychotherapy/psychoanalytics. He’s also created plays such as Room for one Woman and Napoleon’s dinner. With his wife Janet Surrey, they are authors of the play Bill W. and Dr. Bob, which is about the 2 gentleman who created Alcoholics Anonymous.

It is said that this novel was based on Beth Israel Hospital, where Bergman did his internship. Essentially, the book is about the treatment of interns at the time (late 60s, early 70s). It’s about the power hierarchy and how low quality of life interns live.

There is an excerpt from an interview with the Boston Globe, on the 35th anniversary of his book, describing his inspiration for the satirical novel:

Q.What inspired you to write “The House of God”?

A. All of my writing is about one thing: the danger of isolation and the healing power of good, mutual connection. If you get isolated, as in “The House of God,” you can go crazy. You can commit suicide. It happens in medicine. To put it very simply, during internship, each of us got isolated. We not only got isolated from each other, we got isolated from our authentic experience of the system itself. You start to think: I’m crazy for thinking this is crazy.2

With the recent ’24 no more’ petition, there is a relevant quote from this same interview:

Q. When you heard about the Libby Zion verdict in 1984 [the result of a successful lawsuit brought by the family of a young woman who died while in the care of trainees] did you think: “Now things will finally change?”

A. I definitely did. My first reaction to the verdict was “Hooray.” There are two sides to it, though. I come down barely on the side of what has come to pass, which is making sure doctors are not so tired that they can’t function.

Q. That’s not what I expected you to say. You barely come down on the side of limiting trainees’ work hours?

A. It allows people to have lives and it allows care to be better. I really do think that. The only thing I’m a little concerned about is that since I believe good connection is essential for good medicine, this kind of fragments it a little bit. On the other hand, connecting with the patient is not only a matter of time. It’s a matter of understanding and awareness. Those old docs just could come in and put a hand on your shoulder and make it so the patient wanted to talk to them. But now we don’t always select the people who know how to do it.

Q. In what way are we not selecting those people?

A. We select the smartest, but so many of the smart guys who rise in these hierarchies have no sechel [the Yiddish word for sense]. I’ve said this for 30 years. Look at “The House of God.” The Fat Man [a wise and irreverent resident] is smart as hell and also intuitive and compassionate. I wish he’d really existed when I was an intern.2

In this story, there is also the presence of sexism. We see subordinate roles filled by women (nurse, sisters in ‘awe’ of their intelligent brother, lack of female interns).

From this story ( chapter) there are a few unwritten rules that can be learned: